The author is with the Consumer Society Research Centre, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Am J Public Health. 2021 May;111(5):890-895. doi: 10.2105/AJPH.2020.306016. Epub 2021 Mar 18.
Community-based risk factor modification is today an established approach to chronic disease control and public health practice. This article analyzes the shaping of the North Karelia Project (NKP), an early and influential formulation of the community approach that focused on coronary heart disease prevention in Finland. Instead of targeting only high-risk individuals, NKP aimed to change the culture of the local community. On the basis of archival material and interviews, I first trace the multiple origins of the notion of community in NKP, which combined "internal" factors (local risk factor distribution, the role given to the social environment in chronic disease prevention) and "external" influences (regional origin of the initiative, World Health Organization and national policy concepts of community control and primary health care). Second, I describe the shape of the community intervention in NKP. The project foregrounded social relationships as a way to educate the public and influence norms guiding individual behaviors while subordinating environmental changes of a more structural nature.
基于社区的风险因素修正如今是慢性病控制和公共卫生实践的一种既定方法。本文分析了北卡累利阿项目（NKP）的形成过程，该项目是社区方法的早期和有影响力的表述，专注于芬兰的冠心病预防。与仅针对高风险个体的方法不同，NKP 旨在改变当地社区的文化。基于档案材料和访谈，我首先追溯了 NKP 中社区概念的多个起源，这些起源结合了“内部”因素（当地风险因素分布、社会环境在慢性病预防中的作用）和“外部”影响（该倡议的区域起源、世界卫生组织和国家政策概念的社区控制和初级卫生保健）。其次，我描述了 NKP 中的社区干预措施的形成。该项目将社会关系置于前沿，作为教育公众和影响指导个人行为的规范的一种方式，同时将更具结构性的环境变化置于次要地位。
